It’s certainly an interesting time in health fitness and musculoskeletal pain management. These spaces evolve so rapidly, it’s quite difficult to keep up sometimes.
I become aware of how my head gets committed to a space for the sake of necessity, in terms of learning and clinical practice. But I also recognise that a large part of that learning is, to be ever aware of the world and environment around me and what others are up to.
Now, can we firstly agree that all of us are different? At least a little bit right? And this is where I base most of my arguments from. I’m open to all ideas and all new ideas, provided that they are not implemented in a way that leads an individual to distress or detriment.
So, what is the Core referring to?
This is a tough one for me to answer, for the fact that this term has now been used in so many ways, it perhaps doesn’t mean what I once thought it to mean. So how about I look at what I see in my clinical context and the beliefs of my patients.
It seems to be most commonly (in the patients I see) dredged into an idea of this corset brace that is designed to hold you strong around the mid section. Which closely accompanies an idea that without it, the body and namely the spine, is vulnerable to forces or actions that may damage it. Does that sound about right? Ok.
So when I translate that to anatomy, we see the image of the oblique muscles, the transverse abdominus, the rectus abdominus and the back extensors and lateral flexors. Also the deep muscles of the vertebral column are in amongst it. So lots of stuff is in there. And it’s beautiful and complex and sophisticated and amazing.
And this is where it starts to get sticky.
The history of the Core as I have seen it.
I was trained around 15 years ago. Here in Australia. I was also a patient as I had back pain from playing rugby. So I was deep in the learning of how to manage back pain as it was known in those times.
The ideas at that time circulated around holding your tummy in and pulling up your pelvic floor to support your pelvis and spine. Just a bit, not too much, but making sure it’s enough. But not that way, this way…you get my drift…
It was a commonly driven story. There was evidence to say it was somehow helpful. People did it and they had relief and improved function. Cool. I did it too and I told plenty of patients to as well. We used ultrasounds to assess and “improve” the function of these muscles and it was believed that we were really doing something helpful. And perhaps we were. I certainly have never tried to do something that I knew wasn’t.
This became such a phenomenon, that it is now engrained language in our world. Switch on your core. Hold your core on. Core stability. Core exercises and so on. Great. People are being active and exercising and doing lots of great things. Which makes me happy.
But, as I said before, we are all different. So that generally means, apart from maybe oxygen and basic nutrients and water, there are not many things in this world that we know will be helpful for EVERYONE.
So where am I now?
The problem I see now is, that this stuff isn’t useful for everyone. In fact, sometimes these idea lead to problems for people.
Consider this; if we talk about core STABILITY, that may for some conjur images of core INSTABILITY, which for some looks like spinal damage and significant disability. So, what I see in my clinic is that this fear drives a lot of overactivity of these prinicples of the core – over protection which leads to abnormal function and pain.
This is challenging.
Particularly if someone has back pain, tries to protect it, puts extra pressure on it, makes it more sore, tries to protect more…can you see the unhelpful loop forming?
So it is part of my job to help people know that it is not an essential thing to hold your core on, and for some, it’s downright unhelpful.
So, if it doesn’t work for you, great, let’s find what does. And if it does work for you, then you don’t need my help.
But what does nature tell me?
I like nature. It’s where we come from and where we are. I certainly don’t remember going through biology and anatomy and human movement learning of the point in life where the “core” becomes active and critical for survival.
It’s typically a learned response. To pain, fear or education for whatever reason. It’s mostly a belief. And we know that success can reinforce belief. But then if it doesn’t work, the opposite end looks like more distress and fear and more over protection. That’s my concern with this.
I trust that the body knows what to do. It gets over complicated by our life and society. We are obsessed with trying to make the body more efficient or whatever. Seriously though, it is already amazing. Nature thought of all of this before you did.
The spine is strong as heck. It houses your central nervous system, of course it’s robust. But we are made to think it’s not. For some people it is vulnerable, but that is a very small percentage of us. For the rest of us, it is incredible and is designed to move and be loaded.
That means that is we don’t respect the amazing efficiency of the body as it is, we can cause inefficiency, increased and abnormal loads and shoot ourselves in the foot. We see that holding the core on can create lots more force on the spine, not the opposite, which people think might be what they are doing.
The spine is dynamic and mobile and needs variety and load and all sorts of different things. Not one strict rule.
So what do I tell my patients?
Firstly, every patient and presentation is unique. So I avoid recipes. I no longer teach people to hold their core on though. I don’t believe in that, personally. But if somebody else believes in that I don’t mind.
My problem will be only if there is a clear link between those behaviours, and someone’s pain or disability. Then I am obliged to investigate, if that person wishes me to.
You need to understand that some people hold their core on day and night. It can become overwhelmingly insidious. To the point people lift a pen as they would a 100kg weight, maybe not necessary and fails to respect the wonderful diversity and ability of our body.
I endeavour to help people to understand their bodies and to not perseverate over posture, aesthetics and these dogmatic ideas. We are all individual in our bodies and needs and goals. It is your job to learn how yours works and how to keep doing the things you love.